The U.S. Department of Health and Human Services on Thursday unveiled a series of regulatory actions designed to block access to gender-affirming care for minors, building on broader Trump administration restrictions targeting transgender Americans.
The sweeping proposals — the most significant moves this administration has taken so far to restrict the use of puberty blockers, hormone therapy and surgical interventions for transgender children — include cutting off federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to children and prohibiting federal Medicaid dollars from being used to fund such procedures.
“This is not medicine, it is malpractice,” Health Secretary Robert F. Kennedy Jr. said of gender-affirming procedures in a news conference on Thursday. “Sex-rejecting procedures rob children of their futures.”
Thursday’s announcements would imperil access in nearly two dozen states — including Massachusetts, Rhode Island, Connecticut and New Hampshire — where drug treatments and surgical procedures remain legal and covered by Medicaid, which is funded by federal and state dollars.
The proposals run counter to the recommendations of major U.S. medical societies. And advocates for transgender children strongly refuted the administration’s claims about gender-affirming care.
Chastity Bowick, the executive director of the transgender advocacy nonprofit the Marsha P. Johnson Institute and a Boston-based transgender advocate, says the Trump administration is doing “everything they can to attack the trans and nonbinary community ... so that we feel isolated” — including Thursday’s moves, which she says put lives at risk.
“Gender-affirming care literally saves lives, and I am a testament to that as a Black trans woman who has been on gender-affirming care now for 18 years,” Bowick told GBH News Thursday. “This is not only just medical, it’s also mental. It helps us live in the bodies that we were born in, even though our soul may have been from a different gender.”
Advocates, particularly elders in the LGBTQ+ community, have a responsibility to stand up for transgender and nonbinary youth, Bowick said.
“We will not stop fighting until we continue to take back everything that is taken from us and everything that we already deserve that we don’t have,” she said. “This is only going to make us fight harder and stand stronger, because we have to. Because our trans youth are our future and we’re going to do everything we can to make sure that they get the care that they need.”
Massachusetts has a higher rate of people identifying as transgender or nonbinary than the national average — 1.4% to 0.5% — according to estimates from the Williams Institute. The rate of youth who identify as transgender or nonbinary is even higher, at 3.9%, compared to 1.4% across the United States.
Sen. Ed Markey of Massachusetts condemned the Trump administration’s new rules in a statement Thursday, describing it as a “crusade against the trans community” making it even more difficult to access already limited care.
“Let’s make no mistake: The Trump administration’s actions are not based in any medical or scientific evidence. They are entirely fueled by hate and based in this administration’s obsession with controlling what people do with their own bodies,” Markey wrote in a statement Thursday. “Just like all other families, trans people and their families deserve the right and autonomy to make deeply personal and private decisions about their own health.”
Dominique Lee, President and CEO of Planned Parenthood League of Massachusetts and the Planned Parenthood Advocacy Fund, wrote in a statement Thursday that in Massachusetts, many providers — including Planned Parenthood providers — “can and will” continue providing care to trans and nonbinary youth.
“Care continues,” Lee said. “We will continue to choose compassion over cruelty, science over stigma, and equity over fear.”
Advocates have increased the call to protect gender-affirming care, citing links between access to care and lower rates of suicide.
“The multitude of efforts we are seeing from federal legislators to strip transgender and nonbinary youth of the health care they need is deeply troubling,” said Rodrigo Heng-Lehtinen, of The Trevor Project, a nonprofit suicide prevention organization for LBGTQ+ youth.
Proposed rules would threaten youth gender-affirming care in states where it remains legal
Medicaid programs in slightly less than half of states currently cover gender-affirming care. At least 27 states have adopted laws restricting or banning the care. The Supreme Court’s recent decision upholding Tennessee’s ban means most other state laws are likely to remain in place.
The proposals announced by Kennedy and his deputies are not final or legally binding. Officials must go through a lengthy rulemaking process, including periods of public comment and document rewrites, before the restrictions become permanent. They are also likely to face legal challenges.
But the proposed rules will likely further discourage health care providers from offering gender-affirming care to children and many hospitals have already ceased such care in anticipation of federal action.
Hannah Edwards, executive director of Transforming Families, a support organization for families of transgender youth in Minnesota, said she expects some patients will still be able to get care at private clinics that don’t participate in Medicaid and Medicare.
But that won’t be a solution for all kids seeking care.
Edwards has a 15-year-old transgender daughter and said that there’s a growing sense of fear because of federal government actions, even in a state that’s become a destination for families with transgender children.
“The conversation that constantly happens for my family personally is: Where is our red line when we need to flee the country?” she said.
Nearly all U.S. hospitals care for patients enrolled in Medicare and Medicaid, the federal government’s largest health plans that cover seniors, people with disabilities and low-income Americans. Losing access to those payments would imperil most U.S. hospitals and medical providers.
The same funding restrictions would apply to a smaller health plan, the State Children’s Health Insurance Program, when it comes to care for people under the age of 19, according to a federal notice posted Thursday morning.
Criminalizing Care
The House of Representatives on Thursday voted 216-211 to pass a bill sponsored by Rep. Marjorie Taylor Greene of Georgia that would criminalize gender-affirming care. If enacted, the legislation could mean up to ten years of imprisonment for health care providers who provided gender-affirming care for minors under the age of 18.
The bill, called the “Protect Children’s Innocence Act” would make it a class C felony to treat minors with care like puberty blockers and surgery.
The measure now heads to the GOP-led Senate, but would need Democratic support to pass. In the House vote, three Democrats supported the bill, while four Republicans were opposed.
